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The Business Of Anticoagulation

This is a guest post by Dr. Juliet Mavromatis:


The emergence of a new generation of anticoagulants, including the direct thrombin inhibitor, dabigatran and the factor Xa inhibitor, rivaroxaban, has the potential to significantly change the business of thinning blood in the United States. For years warfarin has been the main therapeutic option for patients with health conditions such as atrial fibrillation, venous thrombosis, artificial heart valves and pulmonary embolus, which are associated with excess clotting risk that may cause adverse outcomes, including stroke and death. However, warfarin therapy is fraught with risk and liability. The drug interacts with food and many drugs and requires careful monitoring of the prothrombin time (PT) and international normalized ratio (INR).

Recently, when I applied for credentialing as solo practioner, I was asked by my medical malpractice insurer to detail my protocol for monitoring patients on anticoagulation therapy with warfarin. When I worked in group practice at the Emory Clinic in Atlanta I referred my patients to Emory’s Anticoagulation Management Service (AMS), which I found to be a wonderful resource. In fact, “disease management” clinics for anticoagulation are common amongst group practices because of the significant liability issues. Protocol based therapy and dedicated management teams improve outcomes for patients on anticoagulation with warfarin. Read more »

*This blog post was originally published at ACP Hospitalist*

“Unintended Consequences” Of Cheaper Generic Drugs?

There’s an article in the New England Journal of Medicine entitled the “Unintended Consequences of Four-Dollar Generic Drugs.“ Ever one to hone in on unintended consequences of all stripes, I quickly clicked through. Oh, dear! What bad could possibly come of making drugs significantly more affordable?

Were more people demanding prescriptions for drugs they didn’t really need now that they were so cheap? (Dream on. I’m still twisting arms to get my high-risk cardiac patients to take their generic statins.) Were pharmacies going out of business, no longer to make ends meet without massive markups on brand name drugs, contributing to skyrocketing unemployment and otherwise adding to the country’s general economic malaise? Were cardiologists’ incomes plummeting because of sagging rates of coronary disease now that everyone could easily afford their beta blockers, ACE inhibitors, and statins?

Or maybe it was something good. I guess, technically, “unintended” doesn’t automatically equal “bad.” What could it be? So I read. And what did I discover? Read more »

*This blog post was originally published at Musings of a Dinosaur*

Is Looking At “Long Term” Impossible In Our Healthcare System?

I spent last week in Gothenburg, Sweden covering the European Committee for the Treatment of Multiple Sclerosis (ECTRIMS) meeting. Lots of good science, lots of excitement over the new oral and targeted therapies coming on the market to treat this awful disease. But what I want to write about isn’t the science, but about how it will play out in the brave new world of healthcare in which we all live in today.

For instance, consider the first oral therapy to hit the market: Gilenya (fingolimod), which the FDA approved in September. Last month Novartis announced the price: $48,000 a year.

This is not a rant against the high cost of drugs, however. It is a rant against the inability of our healthcare system to take the long view of the impact of such drugs, a view that is particularly important with a chronic disease like MS that strikes healthy young adults in their early 20s and 30s. Read more »

*This blog post was originally published at A Medical Writer's Musings on Medicine, Health Care, and the Writing Life*

Top Gripes About Drugs And What They Cost

I used to defend pharmaceutical companies. ”What companies out there have contributed more good? Should care manufacturers make more when all they do is make transportation that breaks after a few years?”

It made sense to me that you should put a pot of gold at the end of the rainbow so that companies are motivated to invent more drugs and innovate. We throw a lot of money to athletes and movie stars who simply entertain us, shouldn’t we do better to those who heal us? I used to say that. I don’t anymore.

No, I don’t think the drug companies are “evil.” People who say that are thinking way to simplistic. These companies are doing exactly what their shareholders want them to do: make as much money as possible for as long as possible. That’s what all companies do, right? They are simply working within the system as it is and trying to accomplish the goal of making money. To say that they should “sacrifice” is foolish. They are simply playing by the rules that have been set out there. Those rules are the thing that has to change. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Generic Drugs: Not So Cheap

I received the following e-mail from a patient (paraphrased):

Dear Dr. Fisher,

Thank you for trying to switch me from lisinopril to generic losartan (Cozaar) to help me with the irritating cough that has been nagging me since I was placed on lisinopril. I did not pick up my prescription, though. At nearly $200 for a three-month supply, I’ve decided to live with the cough, since the same amount of lisinopril costs me about $12.

-Ms. Patient

Interesting how the generic drug market for some drugs only marginally discounts prices. Since the companies that make generics did not have to absorb research and development costs, how do they justify the exorbitant prices? Simple: The middlemen still have to get theirs.

-WesMusings of a cardiologist and cardiac electrophysiologist.

*This blog post was originally published at Dr. Wes*

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